The Scientific World Journal

Volume 2012, Article ID 603539, 11 pages

doi:10.1100/2012/603539
The cientificWorldJOURNAL

Clinical Study
The Effects of Body Acupuncture on Obesity:
Anthropometric Parameters, Lipid Profile, and
Inflammatory and Immunologic Markers

Hamid Abdi,1, 2 Baixiao Zhao,1 Mahsa Darbandi,2 Majid Ghayour-Mobarhan,2, 3

Shima Tavallaie,2 Amir Ali Rahsepar,3, 4 Seyyed Mohammad Reza Parizadeh,2
Mohammad Safariyan,2 Mohsen Nemati,2 Maryam Mohammadi,2
Parisa Abbasi-Parizad,2 Sara Darbandi,2 Saeed Akhlaghi,2 and Gordon A. A. Ferns5
1 Departments of Acupuncture Therapy, Beijing University of Chinese Medicine, Beijing 100029, China
2 Biochemistry and Nutrition Research Center, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS),
Mashhad, Iran
3 Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 9196773117, Iran
4 Young Researchers Club, Mashhad Branch, Islamic Azad University, Mashhad 9187147578, Iran
5 Institute for Science and Technology in Medicine, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, UK

Correspondence should be addressed to Majid Ghayour-Mobarhan, ghayourm@mums.ac.ir

Received 27 September 2011; Accepted 16 November 2011

Academic Editor: Francesco Giallauria

Copyright © 2012 Hamid Abdi et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A randomized controlled clinical trial in 196 obese subjects was performed to examine the effectiveness of body acupuncture
on body weight loss, lipid profile and immunogenic and inflammatory markers. Subjects received authentic (cases) or sham
(controls) acupuncture for 6 weeks in combination with a low-calorie diet. In the following 6 weeks, they received the low-calorie
diet alone. Subjects were assessed at the beginning, 6 and 12 weeks later. Heat shock protein (Hsps)-27, 60, 65, 70 antibody
titers and high sensitivity C-reactive protein (hs-CRP) levels were also assessed. A significant reduction in measures of adiposity
and improvement in lipid profile were observed in both groups, but the levels of anti-Hsp-antibodies decreased in cases only. A
reduction in anthropometric and lipid profile in cases were sustained in the second period, however, only changes in lipid profile
were observed in the control group. Anti-Hsp-antibodies and hs-CRP levels continued to be reduced in cases but in controls
only the reduction in hs-CRP remained. Changes in anthropometric parameters, lipid profile, and anti-Hsp-antibodies were more
evident in cases. Body acupuncture in combination with diet restriction was effective in enhancing weight loss and improving
dyslipidemia.

1. Introduction treatment of obesity one of which is acupuncture. It would

Obesity is becoming increasingly common in the general
population and is associated with several other conditions
such as hypertension, diabetes, dyslipidemia, and cardiovas-
cular disease [1]; these are also increasing in their prevalence.
The general principles for the treatment of obesity are to
achieve weight loss, to maintain this reduction in body
weight following this loss, and to finally reduce the risk
factors for obesity. There are several different modalities for
be desirable to control obesity by safe and effective treatment
modalities, and among the different methods acupuncture
is one of the most popular complementary treatments.
Acupuncture is performed by stimulating particular points
on the skin called acupoints. Among several methods used
for acupoints stimulation [2], needling is one of the most
common methods, and stimulation can either be manual or
electrical (electroacupuncture). Acupuncture has been used
in the treatment of several diseases including obesity [3–5]
2 The Scientific World Journal
and also immune-related diseases, such as allergic disorders,
autoimmune diseases, and immunodeficiency-syndromes
[6–8].
Heat shock proteins (Hsps) are highly conserved pro-
teins expressed by several cell types following exposure
to environmental stresses. Over the past 2 decades, there
has been an increasing interest in the relationship between
Hsps and cardiovascular disease, and particularly whether
an autoimmune response may be implicated by formation
of anti-Hsp antibodies [9]. In this regard, most of the studies
have focused on the relation between cardiovascular disease
and Hsp/anti-Hsp-60, -65, -70 while there is recent evidence
that supports the role of Hsp/anti-Hsp27 in cardiovascular
events (reviewed by Ghayour-Mobarhan et al.) [9]. Wick et
al. [10] propose that autoimmunity to Hsps (formation of
anti-Hsp antibodies) may contribute to the progression of
atherosclerosis [11, 12]. Serum C-reactive protein (CRP) is a
feature of systemic inflammation [13] and is positively asso-
ciated with measures of adiposity such as body mass index
(BMI) and waist circumferences (WCs) as demonstrated by 2
large cross-sectional studies [14, 15]. While obesity is related
to higher levels of CRP [16], following weight loss reduction
in CRP levels has been also reported [17, 18].
There are several studies which have evaluated the effect
of acupuncture in the management of obesity. However,
most studies have methodological limitations, including
small sample size and inadequately controlled study design
[19]. To our knowledge, the effect of acupuncture during
body weight loss has not been evaluated with respect to
inflammatory and immunological markers such as hs-CRP
and anti-HSP antibodies. Thus, we aimed to perform a
randomized controlled clinical trial in patients suffering
from obesity to examine its effectiveness in body weight loss,
changing the lipid profile, and inflammatory and immuno-
logical markers by body acupuncture.
2. Material and Methods
2.1. Study Design and Subjects. Two hundred and twenty
overweight and obese subjects were recruited from the
nutrition clinic, Quem hospital, Mashhad, Iran. In this
study, overweight was defined as a BMI of 25 to <30,
and a BMI of ≥30 was defined as obesity. They neither
had received any other weight control measures nor had
any medical and/or drug history within the last 3 months
before their participation in the study. Participants were
informed about the study both verbally and by written
information sheets. Volunteers were given time to discuss
the study and were encouraged to ask questions. Those who
had exclusion criteria such as diabetes, hypertension, heart
disease, endocrine abnormalities, and pregnancy. Finally,
196 subjects were enrolled into the study after checking for
the inclusion and exclusion criteria. These subjects were
randomized into 2 groups of case and control of body
acupuncture (each group had 98 subjects). The subjects
were aged between 18 and 55 years and had a body mass
index (BMI) between 25 and 45 kg/m2 . Each patient gave
informed written consent to participate in the study, which
was approved by the Mashhad University of Medical Science
Ethics Committee.
Anthropometric and biochemical assessments were mea-
sured before and after treatment. The participants were asked
to follow an isocaloric diet (wash-out diet) for 2 weeks before
starting the trial to match the two groups for initial diet,
and a low-calorie diet for 6 weeks. The low-calorie diet
consisted of 1000 kcal deficit per day, less than the individual
daily energy expenditure. The resting energy expenditure
was calculated using the equation of Harris Benedict [20]
and was used to determine the amount of food per day for
each participant. The wash-out diet and the 6-week dietary
program for each participant were planned by a nutritionist
based on the participant’s energy expenditure. The diet was
prescribed and the participant’s compliance was checked
every week.
Hypercholesterolemia was defined using a serum total-
cholesterol concentration ≥200 mg/dL or treatment with
lipid-lowering drugs, diabetes by fasting plasma glucose level
≥126 mg/dL on ≥2 occasions or treatment with antidiabetic
drugs, and hypertension by blood pressures ≥140/90 mmHg
on ≥2 occasions or if patients were on treatment with
antihypertensive medications [21].
2.2. Acupuncture Treatment in Cases. Eight acupuncture
points on the abdomen, including Tianshu (ST-25) both
sides, Weidao (GB-28) both sides, Zhongwan (REN-12)
Shuifen (REN-9) Guanyuan (REN-4) Sanyinjiao (SP-6), and
additional Points are Quchi (LI-11) and Fenlong (ST-40) for
excess mood (patients with higher energy), and Qihai (REN-
6) and Yinlingqau (SP-9) for deficiency mood (patients
with lower energy) on both lower legs were selected. In the
authentic body-acupuncture group, acupuncture needling
with manipulation and use the normal electric lines of the
electric acupuncture machine (Ying Lee, KWD 808) to 4
needles on the abdomen, two needles (ST-25) and (GB-28)
on each side, was applied for 20 minutes.
In this group, the stainless steel acupuncture needles
(3.8 cm long) were inserted to a depth of approximately
2.5 cm after skin sterilization. The needles in the lower legs
were manipulated by rotating them back and forth until the
subjects had the sensation of De-Xi, a term used in acupunc-
ture to describe a feeling of heaviness in the area surrounding
the locus of insertion. The needles in the abdomen were
applied with electricity. The needles were connected to an
electrical stimulator. Electricity was generated as an output of
programmed pulse voltage, 30–40 Hz, dense-disperse wave,
390 μS square pulse, and at a maximal tolerable intensity,
500 Ω (12–23 V) (a strong but not painful sensation to the
patient). Each acupuncture treatment lasted for 20 minutes.
All subjects were asked to receive two treatment sessions per
week for a total of 6 weeks. After that all patients in both
groups received no acupuncture treatment for next 6 weeks,
but were still given advice to keep going on their diet control.
All needling was done by a specialized acupuncturist.
In sham acupuncture group, for points on the RN
meridian, 0.3 cm laterally to the real location was used,
and needling was very superficially as much as possible.
Other points are located 0.5 cm up and 0.5 cm laterally to
The Scientific World Journal 3

the real location and needling was also very superficially. Table 1: Comparison between clinical and biochemical character-
Disconnected electric lines of the acupuncture machine were istics of participants.
applied to 4 needles, each side two needles (ST-25) and (GB-
Group Real (n = 79) Sham (n = 82)
28), for 20 minutes was also used. No major adverse effects
were observed in any of patients. Age (year) 36.88 ± 0.98 37.41 ± 1.01
Weight (kg) 84.10 ± 1.67 85.02 ± 1.75
2.3. Anthropometric Measurements. For all patients, body Height (cm) 161.08 ± 0.83 160.79 ± 0.92
weight (BW), BMI, and body fat mass were measured Body fat (%) 37.00 ± 0.69 37.08 ± 0.79
by body composition analyzer BC-418 (TANITA, Japan) BMI (Kg/m2 ) 32.30 ± 0.52 32.74 ± 0.59
according to a standard protocol [22]. Height and body WC (cm) 102.39 ± 1.28 100.74 ± 1.36
weight were measured with the subjects dressed in light HC (cm) 113.76 ± 1.03 114.98 ± 1.18
clothing after an overnight fasting. The body weight of each WC/HC ratio 0.90 ± 0.1 0.87 ± 0.008
subject was measured with a standard scale to an accuracy FBS (mg/dL) 84.48 ± 1.46 87.76 ± 2.58
of ±0.1 kg, and height was measured to an accuracy of TC (mg/dL) 173.54 ± 4.13 171.96 ± 4.11
±0.1 cm. Hip circumference (HC) was measured at the levels
TG (mg/dL) 112.48 ± 6.24 123.58 ± 5.8
of the major trochanters through the pubic symphysis, and
HDL-C (mg/dL) 42.60 ± 0.99 41.65 ± 1.06
waist circumference (WC) was measured midway between
LDL-C (mg/dL) 108.19 ± 3.44 107.46 ± 3.05
the lateral lower rib margin and the iliac crest with the scale
to the nearest ±0.1 cm. The body mass index (BMI) was DBP (mmHg) 73.33 ± 1.71 75.95 ± 1.67
calculated as weight (kg) divided by height squared (m2 ). SBP (mmHg) 107.91 ± 1.92 107.38 ± 1.77
Anti-HSP27 antibody 0.37 (0.32–0.41) 0.35 (0.33–0.41)
Anti-HSP60 antibody 0.74 (0.68–0.86) 0.72 (0.69–0.78)
2.4. Collection of Blood Samples. Blood samples were taken
Anti-HSP65 antibody 0.81 (0.73–0.90) 0.81 (0.78–0.83)
from each patient for analysis after a 12-hour fasting, 3 times
during the study (at the beginning, 6 and 12 weeks later). Anti-HSP70 antibody 0.59 (0.55–0.67) 0.61 (0.57–0.66)
Following venepuncture, blood samples were collected into hs-CRP (mg/dL) 1.78 (1.15–3.06) 1.79 (0.99–3.39)
Vacutainer tubes and centrifuged at 10,000 g for 15 min at BMI: body mass index; WC: waist circumference; HC: hip circumference;
4◦ C. Hemolyzed samples were excluded from analysis. After FBS: fasting blood sugar; TC: total cholesterol; TG: triglycerides; HDL-
C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein
separation, aliquots of serum were frozen at −80◦ C until cholesterol, DBP: diastolic blood pressure, SBP: systolic blood pressure,
analysis. Anti-Hsp antibody: Anti-heat shock protein, hs-CRP: high-sensitivity C-
reactive protein. Values are expressed as mean ± SEM, or median and
interquartile range. Chi-square test (for qualitative variable), independent
2.5. Routine Biochemical Analysis and Serum Anti-HSP-27, sample t-test (for normally distributed data), and Mann-Whitney test (for
60, 65, 70 Antibody Titers. A full-fasted lipid profile com- non-normally distributed data) were used for comparison 2 groups.
prising total cholesterol, triglycerides, high-density lipopro-
tein cholesterol (HDL-C), and low-density lipoprotein-
cholesterol (LDL-C) were determined for each subject. 3. Results
Serum lipid and fasting blood sugar (FBS) concentrations
3.1. Demographic Data. One hundred and ninety-six par-
were measured enzymatically with the use of commercial
ticipants fulfilled the inclusion criteria. Then, they were
kits. hs-CRP was measured by a PEG-enhanced immuno-
divided into 2 groups (cases and controls) including 98
turbidimetry method with an Alycon analyzer (ABBOTT, subjects. By the end of the study 35 subjects withdrew
Chicago, Ill, USA). Serum HSP27, 60, 65, 70 antibody titers for personal reasons and 161 participants completed the
were measured using an in-house ELISA assay, as we have study (Figure 1). The analysis showed that sex, age, basal
explained before [11, 23]. levels of anthropometric parameters, lipid profiles, and
also levels of anti-Hsp27 antibodies and hs-CRP were not
2.6. Statistical Analysis. SPSS software (version 16, Chicago, significantly different between case and control groups (P >
Ill, USA) was used to perform the statistical analysis. Data 0.05) at baseline. Clinical and biochemical characteristics of
were checked for normality. Values were expressed as mean ± participants have been summarized in Table 1.
SEM or, in the case of nonnormally distributed data (like
triglyceride), as median and interquartile range. Data that 3.2. Comparison at First 6 Weeks (First Period). In the
were normally distributed were analyzed using Student’s authentic acupuncture body group, in the first period of
t-test. Data found to be nonnormally distributed were intervention including both acupuncture and low-calorie
analyzed using the nonparametric Mann-Whitney test. For diet, in authentic acupuncture subjects significant reduction
comparison between two related samples, the paired t- in body weight (P < 0.001), body fat percentage (P < 0.001),
test (normally distributed data) and the Wilcoxon signed BMI (P < 0.001), WC (P < 0.001), HC (P < 0.001), total
ranks test (non-normally distributed data) were used. For cholesterol (P < 0.001), triglyceride (P < 0.001), HDL-C
multiple comparisons of parameters Bonferroni corrections (P < 0.05), and LDL-C (P < 0.001) was observed. In the
were used. A two-sided P value of <0.05 was considered sham body acupuncture group, after 6 weeks of intervention,
statistically significant. body weight (P < 0.001), body fat percentage (P < 0.001),
4 The Scientific World Journal

220 subjects were assessed for eligibility

of body acupuncture

24 subjects were
excluded

196 obese subjects enrolled in the study

Randomized into 2 groups

98 subjects in 98 subjects in
case group control group

Treated for 6 Treated for 6

weeks weeks

13 subjects 11 subjects
withdrew withdrew

85 subjects remained 87 subjects remained

All anthropometric and biochemical factors were measured subsequent to an overnight fasting after 6
weeks of acupuncturing

Patients undergo for the second 6 weeks just having diet and exercise but not needling

6 subjects 5 subjects
withdrew withdrew

Measuring of all anthropometric and biochemical factors to compare changes

79 subjects were 82 subjects were

analyzed in real group analyzed in sham group

Figure 1: Trial profile and design.

BMI (P < 0.001), WC (P < 0.001), HC (P < 0.001), total
cholesterol (P < 0.01), HDL-C (P < 0.001), and LDL-C
(P < 0.01) were reduced significantly. Interestingly in the first
period of study, all immunological (anti-Hsp antibodies) but
not inflammatory (hs-CRP) factors decreased significantly in
cases but not in controls (P < 0.001), however, just anti-
HSP60 antibodies where reduced statistically (P < 0.05).
Table 2 summarizes the levels of different parameters.
In the control group, significant changes were observed
for triglyceride (P < 0.01), HDL-C (P < 0.001), and
LDL-C (P < 0.05). The same as the first period of the
study, all immunological and inflammatory factors including
anti-Hsp antibodies and hs-CRP levels continued their
reduction significantly in authentic group (P < 0.001),
while in controls no statistically changes were seen for these
parameters except for hs-CRP (P < 0.001) (Table 2).

3.3. Comparison at Second 6 Weeks (Second Period). In
the authentic acupuncture group, in the second period
of intervention including just low-calorie diet, significant
changes were found in body weight (P < 0.001), BMI (P <
0.01), WC (P < 0.001), HC (P < 0.001), triglyceride (P <
0.01), HDL-C (P < 0.001), and LDL-C (P < 0.001).
3.4. Comparison the Whole Period of the Study. After 12
weeks of study, in cases of acupuncture body group, sig-
nificant changes were found in body weight (P < 0.001),
BMI (P < 0.001), WC (P < 0.001), HC (P < 0.001), total-
cholesterol (P < 0.001), triglyceride (P < 0.001), HDL-C
(P < 0.001), and LDL-C (P < 0.001) (Table 2). In the control
The Scientific World Journal 5

Table 2: Comparison of clinical and biochemical characteristics of participants of body group.

Real group Sham group

Variable
1st sample 2nd sample 3rd sample 1st sample 2nd sample 3rd sample
Weight (kg) 84.10 ± 1.67 81.23 ± 1.68α 81.27 ± 2.41α,β 85.02 ± 1.75 82.81 ± 1.81α 84.96 ± 2.56α
Body fat (%) 37.00 ± 0.69 36.03 ± 0.7α 37.91 ± 1.91 37.08 ± 0.79 36.54 ± 0.84α 36.35 ± 1.01α
BMI (Kg/m2 ) 32.30 ± 0.52 31.17 ± 0.53α 30.98 ± 0.62α,β 32.74 ± 0.59 31.87 ± 0.61α 31.73 ± 0.74α
WC (cm) 102.39 ± 1.28 95.12 ± 1.2α 92.90 ± 1.43α,β 100.74 ± 1.36 96.66 ± 1.26α 97.16 ± 1.31α
HC (cm) 113.76 ± 1.03 106.59 ± 0.93α 105.84 ± 1.19α,β 114.98 ± 1.18 111.10 ± 1.15α 110.40 ± 1.48α
WC/HC ratio 0.90 ± 0.1 0.89 ± 0.01 0.087 ± 0.01 0.87 ± 0.008 0.87 ± 0.007 0.88 ± 0.008
FBS (mg/dL) 84.48 ± 1.46 87.46 ± 1.33 87.27 ± 3.1 87.76 ± 2.58 89.64 ± 3.40 90.03 ± 3.37
TC (mg/dL) 173.54 ± 4.13 148.18 ± 3.92α 137.98 ± 3.71α,β 171.96 ± 4.11 162.23 ± 3.72α 157.15 ± 3.82α
TG (mg/dL) 112.48 ± 6.24 92.51 ± 4.40α 87.69 ± 4.55α,β 123.58 ± 5.8 122.97 ± 5.68 108.76 ± 6.37α,β
HDL-C
42.60 ± 0.99 38.51 ± 0.88α 54.33 ± 2.96α,β 41.65 ± 1.06 38.16 ± 0.94α 53.05 ± 3.01α,β
(mg/dL)
LDL-C
108.19 ± 3.44 91.34 ± 3.48α 74.50 ± 3.60α,β 107.46 ± 3.05 99.92 ± 2.89α 93.27 ± 3.12α,β
(mg/dL)
Anti-HSP27 0.37 (0.32–0.41) 0.33 (0.29–0.37)α 0.31 (0.28–0.34)α,β 0.35 (0.33–0.41) 0.36 (0.32–0.39) 0.36 (0.33–0.41)
Anti-HSP60 0.74 (0.68–0.86) 0.73 (0.62–0.80)α 0.70 (0.62–0.77)α,β 0.72 (0.69–0.78) 0.73 (0.68–0.78)α 0.73 (0.67–0.78)
Anti-HSP65 0.81 (0.73–0.90) 0.80 (0.73–0.86)α 0.77 (0.70–0.83)α,β 0.81 (0.78–0.83) 0.80 (0.77–0.84) 0.80 (0.77–0.84)
Anti-HSP70 0.59 (0.55–0.67) 0.56 (0.52–0.64)α 0.54 (0.50–0.60)α,β 0.61 (0.57–0.66) 0.60 (0.57–0.65) 0.61 (0.56–0.66)
hs-CRP
1.78 (1.15–3.06) 1.3 (1.3–3.0) 0.8 (0.23–1.4)α,β 1.79 (0.99–3.39) 1.3 (1.3–3.2) 1.10 (0.33–2.00)α,β
(mg/dL)
R: Real; S: Sham; BMI: Body mass index; WC: waist circumference; HC: Hip circumference; FBS: Fasting blood sugar; TC: total cholesterol; HDL-C: high-
density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; DBP: diastolic blood pressure; SBP: systolic blood pressure. Values are expressed as
mean ± SEM, or median and interquartile range. α means significant changes in comparison with first sample and β means significant changes in comparison
with second sample.

group, body weight (P < 0.001), body fat percentage (P <
0.001), BMI (P < 0.001), HC (P < 0.001), total cholesterol
(P < 0.001) and triglycerides (P < 0.01), HDL-C (P <
0.01), and LDL-C (P < 0.001) changed significantly. Overall,
immunological and inflammatory factors including anti-
Hsp27 antibodies and hs-CRP levels decreased significantly
(P < 0.001) in the authentic but not control group, except
the hs-CRP levels which also significantly reduced in control
subjects (P < 0.001) (Table 2).
3.5. Comparison between Changes in the First and Second
Periods of Study. In the acupuncture group, changes in the
first (acupuncture and low-calorie diet) versus second (only
low-calorie diet) period was significantly different for body
weight (P < 0.001), BMI (P < 0.001), WC (P < 0.001),
HC (P < 0.001), total cholesterol (P < 0.001), triglycerides
(P < 0.01), HDL-C (P < 0.001), and hs-CRP (P < 0.05). In
all above parameters except HDL-C and hs-CRP, the changes
were more significant in the first period when compared
with second one. In acupuncture control group, body weight
(P < 0.01), WC (P < 0.001), HC (P < 0.05), HDL-C
(P < 0.001), and anti-Hsp27 (P < 0.05) were significantly
different. All above changes were more significant for the
first period of study compared with second period except the
HDL-C (Table 3).
3.6. Comparison of the Changes in Different Parameters
between the Case and Control Groups. For anthropometric
parameters, acupuncture was more effective for reducing
body weight in all 3 periods of the study (P < 0.05), BMI
in the first period of the study (P < 0.05), WC in all 3 periods
of the study (P < 0.05), and HC in the first and whole period
of the study (P < 0.001). For lipid profile, total-cholesterol
in the first and whole periods (P < 0.05), triglycerides in the
first period (P < 0.01), and LDL-C in the first and whole
period of the study were significantly and more effectively
reduced by authentic body acupuncture.
With regards to immunological markers, authentic body
acupuncture was more effective as we observed that anti-
Hsp27 antibodies were significantly reduced in the all 3 peri-
ods of the study when, compared with control acupuncture
(P < 0.001). The same results were observed for other anti-
Hsps (P < 0.001). However, the marker of inflammation,
hs-CRP was not significantly changed between cases and
controls (P > 0.05).
4. Discussion
In the first period of the study, a significant reduction in
anthropometric and lipid profile was observed in both cases
and controls, but the levels of anti-Hsp antibodies were
found to fall in cases but not controls. In the second period
which provides evidence for the ability of acupuncture to
produce a sustained reduction in anthropometric and lipid
profile, whilst in the control group, only changes in lipid
profile were sustained. As before, anti-Hsp antibodies and
 6

Table 3: Comparison of changes in clinical and biochemical characteristics of body acupuncture.

Real group Sham group
Variable P value P value P value
1st period 2nd period Whole period 1st period 2nd period Whole period
1 v. 2 1 v. 2 R. v. S.
1st P: 0.019
Weight (kg) 2.98 ± 0.22 1.22 ± 0.18 4.15 ± 0.37 0.000 2.21 ± 0.23 0.29 ± 0.29 2.40 ± 0.60 0.001 2nd P: 0.006
3rd P: 0.012
1st P: 0.632
Body fat (%) 0.90 ± 0.18 −1.39 ± 1.72 −0.38 ± 1.70 0.177 0.77 ± 0.20 0.43 ± 0.40 1.22 ± 0.35 0.507 2nd P: 0.326
3rd P: 0.377
1st P: 0.038
BMI (Kg/m2 ) 1.16 ± 0.09 0.29 ± 0.10 1.47 ± 0.14 0.000 0.86 ± 0.10 0.47 ± 0.27 1.24 ± 0.16 0.221 2nd P: 0.523
3rd P: 0.294
1st P: 0.000
WC (cm) 7.05 ± 0.60 1.76 ± 0.40 8.93 ± 0.79 0.000 4.07 ± 0.52 −0.50 ± 0.93 3.97 ± 0.92 0.000 2nd P: 0.020
3rd P: 0.000
1st P: 0.000
HC (cm) 7.16 ± 0.40 1.63 ± 0.37 8.70 ± 0.56 0.000 3.76 ± 0.56 1.17 ± 0.68 5.49 ± 0.64 0.011 2nd P: 0.538
3rd P: 0.000
1st P: 0.926
WC/HC ratio 0.007 ± 0.006 0.003 ± 0.004 0.015 ± 0.008 0.384 0.006 ± 0.005 −0.01 ± 0.008 −0.005 ± 0.008 0.106 2nd P: 0.064
3rd P: 0.095
1st P: 0.780
FBS (mg/dL) −2.70 ± 1.39 −0.70 ± 3.43 −3.61 ± 2.98 0.611 −2.08 ± 1.74 2.83 ± 2.03 0.45 ± 1.58 0.170 2nd P: 0.388
3rd P: 0.237
1st P: 0.001
TC (mg/dL) 25.35 ± 2.60 7.52 ± 2.99 32.62 ± 3.59 0.000 10.98 ± 3.58 6.80 ± 3.44 18.51 ± 4.46 0.456 2nd P: 0.873
3rd P: 0.014
1st P: 0.002
TG (mg/dL) 19.97 ± 3.55 5.73 ± 2.52 25.97 ± 5.53 0.003 1.48 ± 5.85 17.19 ± 6.84 21.82 ± 7.57 0.530 2nd P: 0.200
3rd P: 0.357
1st P: 0.974
HDL-C (mg/dL) 4.02 ± 0.97 −16.07 ± 2.88 −12.12 ± 3.12 0.000 3.97 ± 0.99 −13.15 ± 2.80 −10.64 ± 3.11 0.000 2nd P: 0.471
3rd P: 0.739
1st P: 0.017
LDL-C (mg/dL) 17.17 ± 2.23 15.19 ± 2.96 31.85 ± 3.13 0.734 9.03 ± 2.55 7.22 ± 2.80 15.34 ± 3.29 0.581 2nd P: 0.054
3rd P: 0.000
1st P: 0.000
Anti-HSP27
0.03 (0.01–0.06) 0.02 (0.0–0.04) 0.05 (0.02–0.08) 0.083 0.01 (−0.01–0.02) −0.01 (−0.02–0.01) 0.0 (−0.01–0.02) 0.028 2nd P: 0.000
Antibody
3rd P: 0.000
1st P: 0.000
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Table 3: Continued.
Real group Sham group
Variable P value P value P value
1st period 2nd period Whole period 1st period 2nd period Whole period
1 v. 2 1 v. 2 R. v. S.
Anti-HSP60
0.03 (0.02–0.05) 0.02 (0.01–0.05) 0.06 (0.04–0.09) 0.114 0.01 (−0.007–0.02) 0.0 (−0.01–0.02) 0.01 (−0.01–0.02) 0.264 2nd P: 0.000
Antibody
3rd P: 0.000
1st P: 0.003
Anti-HSP65
0.02 (−0.01–0.05) 0.03 (0.01–0.05) 0.05 (0.03–0.08) 0.370 0.01 (−0.01–0.02) 0.005 (−0.01–0.017) 0.01 (−0.01–0.02) 0.569 2nd P: 0.000
Antibody
3rd P: 0.000
1st P: 0.000
Anti-HSP70
0.02 (0.01–0.04) 0.02 (0.01–0.04) 0.05 (0.03–0.07) 0.936 0.01 (−0.01–0.02) −0.005 (−0.02–0.01) 0.0 (−0.01–0.02) 0.096 2nd P: 0.000
Antibody
3rd P: 0.000
1st P: 0.790
hs-CRP (mg/dL) 0.0 (−0.63–0.94) 0.90 (0.15–1.7) 1.06 (0.18–1.47) 0.024 0.0 (−0.58–0.75) 0.8 (0.1–1.60) 0.62 (0.13–1.39) 0.226 2nd P: 0.691
3rd P: 0.256
R: real; S: sham; BMI: body mass index; WC: waist circumference; HC: hip circumference; FBS: fasting blood sugar; TC: total cholesterol; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density
lipoprotein cholesterol, DBP: diastolic blood pressure, SBP: systolic blood pressure. Values are expressed as mean ± SEM, or median and interquartile range. Paired t-test and Wilcoxon signed ranked test were used
for comparison between first and second periods for normally and nonnormally distributed data, respectively. Independent sample t-test (for normally distributed data) and Mann-Whitney test (for non-normally
distributed data) were used for comparison 2 groups.
7
8 The Scientific World Journal
hs-CRP levels continued to fall in cases while no significant
changes were observed in controls except hs-CRP. When the
whole period of the study was assessed, the reduction in
anthropometric, lipid profile and also hs-CRP levels were
observed in both cases and controls, but the changes in
anti-Hsp antibodies were only statistically significant in the
group treated with authentic acupuncture. In addition, the
analysis showed that changes in most of the parameters
were more significant in the first period of the study
when acupuncture were accompanied with diet restriction,
compared with second period consisting of diet restriction
only. Moreover, changes in anthropometric parameters, lipid
profile, and anti-Hsp antibodies were more significant in
cases in comparison with the control group. However, the
changes in hs-CRP level were not significantly different.
Changes in anthropometric and lipid profile in the first,
second, and whole period of the study have been summarized
in Figure 2.
Consistent with our results, indicating the greater efficacy
of body acupuncture therapy for reduction of anthropomet-
ric parameters in cases when compared with controls, there
are other studies reporting similar findings. Hsu et al. [4]
performed a randomized crossover trial in obese women and
found that anthropometric parameters changed significantly
by electroacupuncture when compared with sit-up exercise.
The same results have been found by other studies [3, 5].
However, there are some studies that have reported no
significant effect of acupuncture in the treatment of obesity,
but it should be noted that these studies were performed by
auricular acupuncture therapy [24–26].
It is thought that acupuncture exerts its effects on weight
loss through different mechanisms. In terms of traditional
medicine, it is believed that acupuncture alters levels of
central nervous system by stimulating peripheral nerves
at acupoints. Signals are then carried by stimulated nerve
resulting in changes in satiety and mood. These mechanisms
have been reviewed by Lacey et al. [2]. Acupuncture appears
to be able to improve mood by increasing the release of neu-
rotransmitters [27] and suppress appetite by the serotonin
and endorphin-induced decreases in stress and depression
[28, 29], whereas this effect was not seen by exercise and
diet. In addition, it has been shown that application of
electroacupuncture at Zusanli (ST-36) and Neiting (ST-44)
of the rat caused the increase in the electrical activity of
ventral-medical hypothalamus in the obese rat, leading to
activation of the satiety center [30]. Waist circumference is
related to the subcutaneous fat tissue of the abdomen, and
higher effects of body acupuncture in lipolitic activity and
enhancing lipid metabolisms could be attributed to the direct
effects of body acupuncture in redistribution, lyses of fat
tissue [5], and reducing waist circumferences.
Concerning the effects on lipid profile in both cases and
controls, positive changes (increase in levels of HDL-C and
decrease in other parameters including triglycerides, total-
cholesterol and LDL-C) were observed, however, the changes
were significantly different between 2 groups being higher
for acupuncture body group, indicating that whilst diet had
important effects on the lipid profile but the combination of
diet restriction and acupuncture therapy, leads to a further
improvement in lipid profile levels. Moreover, Li and Wang
[31] have reported significant changes in total and LDL
cholesterol in during acupuncture therapy when compared
with control subjects. In other study, it was reported that
a significant decrease of triglyceride, total cholesterol, LDL-
C but no changes in HDL-C in acupuncture group when
compared with controls [32]. In several studies, a similar
pattern of changes in triglyceride, total-cholesterol, LDL-
C, and HDL-C changed has been reported as our study
following acupuncture [19, 33, 34], however, 2 of these
studies did not find any changes for HDL-C [19, 32], this
may be explained by application of different acupoints. It has
been suggested that these changes in lipid metabolism may be
caused by increase in the serum betaendorphin levels [32].
Reduction in anti-Hsp antibodies in all periods of the
study was significant only in authentic group in comparison
with controls. Moreover, in the first period of the study
when acupuncture combined with diet restriction, this
finding was more prominent. To our knowledge, no study
has evaluated the effects of acupuncture therapy on these
antibodies. However, in a study, it has been reported that
dietary constituents are associated with immune response
to Hsps in dyslipidemic patients [23]. Our results indicate
that acupuncture therapy may have direct effects on immune
system and modulates the function of our immunity. As
previously noted, these anti-Hsp antibodies have a potential
pathologic role in atherogenesis and may progress further
inflammatory processes.
Moreover, as reviewed by Cabyoglu et al. [35], ac-
upuncture is able to increase the levels of encephalin,
endomorphin-1, beta endorphin, serotonin, and dopamine
and has immunomodulator effects on immune system and
lipolitic effects on metabolism. These may be caused by the
direct impression of body acupuncture on the adipose tissue
of the abdomen. As the results show, body acupuncture
was more effective in reduction of waist and hip circum-
ferences, which means the greater losing of adipose tissue
of the abdomen, leading to production of less inflammatory
markers for the stimulation of the immune system. This role
is suggested to be explained by the interaction between the
autonomic nervous system (ANS) and the immune functions
and the brain as the communicator between 2 systems [36].
By communicating with brain the inflammatory cytokine
stimulate neural outflow via the ANS [36], leading to release
of acetylcholine via parasympathetic nerve (vagus) endings,
resulting to neuroimmune reflex and suppressing the release
of inflammatory cytokines [36]. However, it should be
noted that this could be a part of the mechanism of how
acupuncture works, as we know despite the auricle that vagus
nerve is superficial and can be stimulated by acupuncture
leading to release of acetylcholine via parasympathetic nerve
(vagus) endings, during body acupuncture vagus nerve
does not stimulate directly and it should be some other
explanatory mechanism.
In addition, reductions in hs-CRP levels were seen in
different periods of the study in both groups, interestingly,
the analysis showed that changes in hs-CRP levels were
not different between cases and control, implying this
notion that hs-CRP changed independent of the effects of
The Scientific World Journal 9

9 30
∗∗∗ ∗∗
8
∗∗∗ 25 ∗∗
7
∗
6 20
5
∗ 15
4
3 10
2 ∗
5
1
0 0
−1 Weight BMI BF% WC HC TC HDL-C LDL-C TG

(a)
3 ∗ 30
∗∗ 25
2 20
1 15
10
0 5
Weight BMI BF% WC HC 0
−1 −5 TC HDL-C LDL-C TG
−2 −10
−15
−3 −20

(b)
12 40 ∗ ∗∗∗
∗∗∗
10 ∗∗∗
30
8
20
6 ∗
10
4
0
2
TC HDL-C LDL-C TG
0 −10

−2
Weight BMI BF% WC HC
−20
(c)
Real group Real group
Sham group Sham group

Figure 2: Changes of anthropometric parameters and lipid profile in real and sham groups. BMI: body mass index, BF%: body fat percentage,
WC: waist circumferences, HC: hip circumferences, TC: total cholesterol, HDL-C: high density lipoprotein-cholesterol, LDL-C: low density
lipoprotein-cholesterol, TG: triglycerides. (a), (b) and (c) means first, second and whole period of the study, respectively, ∗ P < 0.05, ∗∗ P <
0.01, and ∗∗∗ P < 0.001, respectively.

acupuncture. There are evidences that demonstrate the fact also reduction of the obesity-associated risks factors, such as
that elevated CRP levels are closely related to obesity [16]. dyslipidemia. However, these effects can be achieved by other
It has been also suggested that adipose tissue releases the modalities but due to lack of adverse events and continued
proinflammatory cytokines [37], so it is logical that weight effects after the therapy, acupuncture could be used as a
loss is associated with decrease in CRP levels. Other studies proffered or synergic treatment option for obesity control.
have found the same result as ours about the reduction Moreover, it was found that it has immunomodulatory
in CRP levels following weight loss [17, 18]. Although but not anti-inflammatory effects on immune system by
there are no studies assessing the role of acupuncture on regulation of the levels of anti-Hsp antibodies.
hs-CRP changes during weight loss, but there are some
studies which have evaluated the changes in hs-CRP levels
in rheumatologic diseases. Similar to our results in patients
Abbreviations
with rheumatologic problems, some studies reported the BMI: Body mass index
inability of acupuncture to reduce the hs-CRP levels [38, 39] WC: Waist circumference
and some other not [40]. HC: Hip circumference
In conclusion, body acupuncture in combination with FBS: Fasting blood sugar
diet restriction was found to be effective for weight loss and TC: Total cholesterol
10
TG: Triglycerides
HDL-C: High-density lipoprotein cholesterol
LDL-C: Low-density lipoprotein cholesterol
DBP: Diastolic blood pressure
SBP: Systolic blood pressure
Anti-Hsp antibody: Antiheat shock protein and
hs-CRP: High-sensitivity C-reactive protein.
Acknowledgments
The authors are particularly grateful to the patients and their
family members who volunteered to participate in this study.
This work was supported by Iranian Ministry of Health
and Education, Mashhad University of Medical Science
(MUMS), Iran and Beijing University of Chinese Medicine,
China. The Grant number of this study was 86058 in medical
research council of Mashhad University of Medical Science
(MUMS). B. Zhao and H. Abdi Both contributed equally as
the first author.
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